Provider Demographics
NPI:1477285864
Name:AGUINAGA, MARIO A (AGACNP-DNP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:AGUINAGA
Suffix:
Gender:M
Credentials:AGACNP-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 GAINES MILL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8073
Mailing Address - Country:US
Mailing Address - Phone:678-629-1626
Mailing Address - Fax:
Practice Address - Street 1:199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2400
Practice Address - Country:US
Practice Address - Phone:706-475-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269637363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN269637OtherGEORGIA BOARD OF NURSING